Care Home: Amphion View Limited

What the care home does well Staff were friendly and available to assist people living in the service. The home was clean and tidy with a happy atmosphere. What the care home could do better: To continue to improve and maintain the consistency in medication management to safeguard the health and safety of the people living in the service. Random inspection report Care homes for older people Name: Address: Amphion View Limited 17/19 Avenue Road Wheatley Doncaster DN2 4AQ one star adequate service 27/07/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Mathias Foundling-Miah Date: 1 6 0 2 2 0 1 0 Information about the care home Name of care home: Address: Amphion View Limited 17/19 Avenue Road Wheatley Doncaster DN2 4AQ 01302595959 Telephone number: Fax number: Email address: Provider web address: mue@amphion.co.uk Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Amphion View Limited care home 35 Number of places (if applicable): Under 65 Over 65 35 dementia Conditions of registration: 35 The maximum number of service users who can be accommodated is:35 The registered person may provide the following category of service only: Care Home with Nursing Code N To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following category: Dementia Code DE, maximum number of places 35 Date of last inspection Brief description of the care home Amphion View is a registered service that is able to provide care and support to a maximum of fourteen people who may have dementia care needs. The home is situated in a residential avenue in Doncaster and is close to local shops and amenities. Bus services to the city centre are a short walk away. The home has fourteen single bedrooms, all of which are ensuite and located over two floors accessed by a passenger lift. Communal rooms consist of one lounge and a large Care Homes for Older People Page 2 of 11 2 7 0 7 2 0 0 9 Brief description of the care home dining room with comfortable seating at one end overlooking the garden. The garden is accessed via patio doors and has a paved area with garden furniture and a large lawn. The home has two bathrooms, one of which has a hoist to assist people in and out of the bath. The other has an unassisted bath and is for more ambulant people. The proprietors have plans to renovate this bathroom into a walk-in shower room. There is parking for a few cars in the driveway and in the avenue in front of the building. According to information received from the home the weekly fees are £435.93p. Additional charges are made for hairdressing, chiropody, clothing and toiletries. Information about the home and services can be located in the statement of purpose and welcome pack provided to prospective residents and available from the manager on request. The homes inspection report, will also be on display in the home. Care Homes for Older People Page 3 of 11 What we found: Previous concerns were evidenced during a visit by Sue Turner (Regulation Inspector) on a Key Inspection on 27th July 2009. The reason for the pharmacist Inspection visit on 16th February 2010 was from concerns recently received and raised by Stephen Robertshaw (Regulation Inspector) and due to the recent registration as nursing with EMI. The pharmacist Inspection visit involved examination of medicines, storage facilities, medicine charts and records. We case tracked three people living in the service. Discussions took place with the Registered Manager, Duty Manager and the Nurse in charge of medication, during the time of the inspection. Feedback was provided and the outcome of this inspection is as follows: The previous three requirements in medication standards have been met. The Residential and Nursing Drug Trolley including controlled Drug (CD) cabinets were kept in separate treatment rooms. They were all found to be locked, clean and tidy. The management was actively willing during this inspection to make improvements in the home. We were informed that there were previous concerns of greater quantity of medication for epilepsy remaining in stock compared to the Medication Administration Record (MAR) charts. The registered Manager has monitored this carefully by arranging a system where two staff sign a chart after each administration and witnessed as well as the MAR chart. We observed that the home had different brands of this epilepsy medication and was unaware that the pharmacy should supply the same brand to ensure its effectiveness. We observed the home has arranged a system to monitor staff signing the MAR chart. We were informed by the registered manager that we have a name and shame policy when they have not signed the chart. We were informed that the registered Manager regularly checked the MAR sheets a couple of times per week. We were informed that they would monitor this monthly and If the same named staff occurs then I will get them into the office. I would ask them why and consider if they needed further training, disciplinary procedure and/or stop them giving medication. This has improved the level of medication management. We were shown documentation but we found this lacked in demonstrating of details when monitoring took place. This made it difficult to fully satisfy that no retrospective signing took place. This also lacked details of what actions were taken for any poor practices that were dealt with by management. During the afternoon of the inspection we observed the nursing staff on duty carrying out the medication round. We observed that they had already dissolved a soluble pain killer in water (prescribed to be given if required) then asked whether the person required this medication. However the person living in the home replied I have no pain, I dont want it The staff wrote down on the back of MAR chart that they refused medication. However this cup of medication was insecurely left on the fireplace mantle next to the drug trolley and we were informed that the staff would try to administer later. The Drug trolley was kept secure at all times. Medicines were administered with a friendly Care Homes for Older People Page 4 of 11 patient approach and in a dignified way. Staff communicated what they were doing in a positive and therapeutic manner. Water was provided and staff signed MAR chart correctly afterwards. We provided feedback that the staff failed to ask a person living in the service whether they were in pain before dissolve their medication. We informed that the cup of dissolved medication was securely kept as this looks like an ordinary drink which could be taken by any person living in the home. Staff were not always aware of an up to date knowledge in the subject of medicines they administered and were not fully aware of the policy and procedures home procedures including if the person rightfully refuses medication. We asked the staff what a particular medication was used for when medicine chart stated one daily if required. A patient Information leaflet was available. Staff did not realise this was to control incontinence. We were informed the person living in the service is incontinent in their bed, most nights. Staff should have administered this medication when this was required. We found no when required (PRN) protocol in place. We spoke to people living in the service and we asked if they were happy with everything. They replied yes and Im fine We were informed PIN no were checked and website name are valid. The Registered Manager had a reasonable understanding of medication management and had put systems in place. The home had some knowledge of the medicines they handled. The Care Home Advisory Team (CHAT) made a recent visit on 26th Jan 2010 reporting a positive good outcome. However we found further improvements were necessary to enable them to fully support the people living in the home and we were satisfied from our discussion that this will be achieved. Sample MAR charts are up to date for each person in service and medicines received, administered and disposed of are generally recorded. Sample examinations of MAR charts were signed. Staff were aware to sign the MAR chart for external preparations and nutritional supplements. During the inspection we conducted an audit of some medicines available for administration and there were adequate supplies of medication. The quantities of all medicines received were recorded. Generally medicines are administered as prescribed. However there was no recording of medicines carried forward from previous months supply which made checking the audit trail difficult. The registered manager agreed that they were unable to fully monitor without knowing how much was actually in stock at any one time. We found any handwritten MAR charts were signed by a second staff to ensure the information written down was correct however this was not dated to verify when this was checked. The front sheets had a photograph to identify each person living in the service including details such for e.g. to avoid grapefruit with their medication. However the front sheets and MAR charts lacked details of any allergies. We were informed that there were two people living in the service who self administer medication, one used an external preparation when required and the other person administered inhalers. However there was no risk assessment and no lockable units made available. We informed the home that any person living in the home self administering their own medication must be risk assessed. The home was to carry out regular compliance checks and document to ensure that they can handle their medication safely. We found self administered medicines were not safely stored in lockable units. Care Homes for Older People Page 5 of 11 We were provided with a training matrix sheet and informed by the manager that systems are in place to support staff and identify training needs. Staff had attended a half day Boots medication handling system training in November 2009. Nine members of staff had undergone a two day medication adminstration training between May to November 2009. The home had no recent medication reference book such as the British National Formulary (BNF) made available as the most recent one was missing. The home lacked medication policies for staff and agency staff to safely and competently follow procedures necessary in this home with regards to the new registration in Nursing with EMI. This could potentially compromise the health and welfare of people living in the home. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 11 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 29 19 Application forms must give full details of peoples previous employment. Any gaps in employment history must be checked out and recorded on the application form. So that people are protected by the homes policies and procedures on the recruitment and selection of staff. 17/08/2009 2 38 13 The fire risk assessment 17/08/2009 must highlight any particular precautions that need to be in place for people that have dementia. So that people are kept safe Care Homes for Older People Page 7 of 11 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 An improved quality 31/03/2010 assurance system must be installed to assess staff competence in their handling of medicines including medicines refused and disposed. Appropriate action must be taken when these indicate that medicines are not administered as prescribed and records do not reflect practice. This must be fully demonstrated. To safeguard the health and welfare of people living in the home The medicine policy must be 30/04/2010 reviewed to ensure that it reflects current practice and relevant to the nursing care at this home, including, administration of medicines by specialised techniques including Buccal Midazolam, Insulin Injection, PEG feed, vaccines, anaphylaxis and Oxygen. The signed policy date and the next review date must be recorded on Page 8 of 11 2 9 13 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action the policy. The staff must receive training to adhere to it. To safeguard the health and welfare of people living in the home 3 9 13 The quantity of all medicines 31/03/2010 received and any balances carried over from previous cycles must be recorded to enable audits to take place to demonstrate the medicines are administered as prescribed. To safeguard the health and welfare of people living in the home Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 Action to be taken that any known allergies must be recorded on the MAR sheet or nil known where appropriate.To liase with the pharmacist to print on the MAR chart. Action to be taken that any person self administering their own medication must be risk assessed as able to, with regular compliance checks undertaken and documented to ensure that they can handle their medication safely which is stored in lockable units. Action to be taken that In house training schemes must have a body of up to date knowledge in the subject of medicines to include medicines with cautionary and advisory measures including for example Insulin, patches, eye drops and when required medicines. Page 9 of 11 2 9 3 9 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 4 9 It is recommended that all medicines prescribed on a when required basis have individual supporting protocols detailing their use for to ensure they are administered as the doctor originally intended. Care Homes for Older People Page 10 of 11 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 11 of 11 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!